About 1/3 of American adults don't drink alcohol in any given year. Of those who do drink, their consumption varies markedly. In particular, heavy drinkers are hugely important customers for alcohol sellers: more than half of the alcohol consumed is drunk by the heaviest 10 percent of the drinking population. (See Philip J. Cook and Michael J. Moore, "The Economics of Alcohol Abuse and Alcohol-Control Policies," Health Affairs 21(2): 120-133, 2002.) Does this mean that most of the social harms associated with alcohol consumption also can be traced to the biggest drinkers? In a word, no. Light and moderate drinkers are probably responsible for more than half of all alcohol-related problems.

Some of the most recent evidence on this phenomenon appears in the April, 2007 edition of the journalAddiction. Actually, the evidence dates from 1969 to 1992, but the analysis has just been provided. The data concern adult Finns who drink, and the problems that were studied were of three types: self-reported alcohol problems, alcohol-related hospital admissions, and alcohol-related deaths. The authors -- Kari Poikolainen, Tapio Paljärvi, and Pia Mäkelä -- divided the drinkers into the heaviest ten percent, and everyone else. For the Finnish men in the sample, the heaviest drinking ten percent consumed just less than half of the alcohol consumed by men; for women, the top ten percent drank slightly more than half of all alcohol consumed by women. Here is an excerpt of the results:

Seventy per cent of all self-reported problems, 70% of alcohol-related hospitalizations, 64% of alcohol-related deaths and 64% of the premature life-years lost before the age of 65 occurred among the 90% of men consuming less. The respective figures for women were 64%, 60%, 93% and 98%. Drinking five or more drinks per occasion was related to more harm than not drinking that much.

So there is a strong case to be made that public policy should target all drinkers, especially all binge drinkers, and not just those who are very heavy drinkers. One policy that does this is the alcohol excise tax, of course.